Automated peritoneal dialysis (APD) consists of dwells with the same dwell volume and time. New cyclers allow modification of time and volume to prescribe adapted APD (AAPD), i.e., a series of short, small dwells followed by long, large dwells. Safety, efficacy, and underlying mechanisms of AAPD in children are uncertain. Two double mini-PET were performed in randomized sequence. The standard test consisted of two identical cycles (fill volume 1000ml/m2, 75min) and the adapted test of a short, small cycle (600ml/m2 BSA, 30min) followed by a long, large cycle (1400ml/m2, 120min). Solute and water fluxes were quantified together with intraperitoneal pressure (IPP). Nine pediatric PD patients (5-21years) were treated per protocol. Residual dialysate volume was 422 ± 190ml/m2 BSA. There were no differences in ultrafiltration rates, glucose uptake, and creatinine, urea, and electrolyte clearances with the adapted and standard double mini-PET, despite identical cumulative dialysate volume and time. IPP varied by 1.7 ± 3.4 (range -2 to 9) cm H2O with a drained volume of 1123 ± 386 and 1159 ± 210ml/m2 BSA for each standard dwell. IPP decreased from 1.9 with small volume to 1.0cm H2O /m2/100ml with large volume dwells (p < 0.001) and was above 14cm H2O in 21 out of 63 measurements. Within the limitation of small patient numbers, this proof-of-concept study suggests similar ultrafiltration and clearance rates with a single adapted versus standard double mini-PET. High residual dialysate volumes and high IPPs highlight the challenges of AAPD prescription in children.

Real-World Dialysis Modality Selection in a Global Mexican Institution: A Multicenter Cross-Sectional Study.

Remote monitoring in peritoneal dialysis and its practical implementation is an important technology to leverage in optimizing automated peritoneal dialysis delivery. The more advanced our remote monitoring capabilities become, the greater the urgency to implement protocols to appropriately utilize and leverage the technology for the betterment of patient care. Debates about its utility tend to center around two main issues: responsibility and skepticism around the findings of studies that examined its utility, owing to a combination of hyperbolic claims and methodology variations. This review discusses the theory behind remote monitoring, the available data and capabilities, and a path forward towards adopting remote monitoring in peritoneal dialysis. Numerous clinical studies have demonstrated the association of remote monitoring protocol implementation with reduced hospitalization rates, shorter hospital stays, decreased automated peritoneal dialysis technique failure, and longer time on peritoneal dialysis. There is a need for standardized remote monitoring in peritoneal dialysis protocols. Fewer reported hospitalization rates, shorter hospital stays, and lower automated peritoneal dialysis (APD) technique rates are some of the findings demonstrated in remote monitoring studies. While it is more costly to implement than traditional automated peritoneal dialysis, the reported benefits of remote monitoring outweigh the cost burden. Patients have an overall positive perception and experiences with remote monitoring-APD. Remote patient monitoring provides an additional invaluable resource to enhance the quality of care delivered to.

BackgroundChronic kidney disease is a growing global health concern, requiring kidney replacement therapy for survival. In Brunei, kidney failure incidence and prevalence are among the highest globally. Despite a peritoneal dialysis preference policy, uptake remains low, straining financial and human resources. With dialysis costs and demand for skilled healthcare workers projected to rise significantly, this study evaluates the cost effectiveness, budget impact, and human resource requirements of alternative dialysis policies to inform sustainable policy decisions.MethodsA Markov model was developed to compare the costs and health outcomes of three policy options under the government and societal perspective: (i) Current Practice, (ii) Automated Peritoneal Dialysis (APD)-first policy, and (iii) Continuous Ambulatory Peritoneal Dialysis (CAPD)-first policy, in which new patients start dialysis with either APD or CAPD respectively unless contraindicated. Budgetary and human resource impacts of each policy were estimated over a five-year period.ResultsAlthough both CAPD-first and APD-first policies show improved health and cost savings relative to the current policy, the APD-first policy is dominant (most cost effective) from the societal and government perspectives. Under the current policy, meeting the demand for Hemodialysis (HD) will require an additional 7 nephrologists and 230 HD nurses, whereas the APD and CAPD-first policies will significantly reduce workforce needs over the next 5-year period.ConclusionsFindings suggest that Brunei’s current policy is not the most cost-effective or sustainable option. A peritoneal dialysis-first approach could generate significant cost savings and reduce additional demand for scarce nephrologists and dialysis nurses. Our results highlight the need to integrate workforce planning into economic evaluation to inform sustainable dialysis policies.

Given the lack of cost-effectiveness information, continuous ambulatory peritoneal dialysis (CAPD) with icodextrin (CAPD+ICO) has not yet been included in the Universal Health Coverage (UHC) scheme. This study aimed to evaluate the cost-utility of dialysis treatments for end-stage renal disease (ESRD) patients with fluid and sodium overload, comparing CAPD+ICO and automated peritoneal dialysis (APD) against glucose-based CAPD. A Markov model was applied to evaluate lifetime costs and health outcomes from a societal perspective. Data, including transitional probabilities, direct medical and non-medical costs, and utilities, were collected from randomized controlled trials conducted across 16 hospitals in various regions of Thailand. Compared to glucose-based CAPD, the incremental cost-effectiveness ratio (ICER) for CAPD+ICO was 908,440 THB (26,082 USD) per quality-adjusted life year (QALY) gained, while APD was dominated, incurring higher costs and yielding fewer QALYs. The results indicated that glucose-based CAPD had a 90% probability of being the most cost-effective option from a societal perspective, based on Thailand's willingness-to-pay (WTP)threshold of 160,000 THB (4,603 USD) per QALY gained. Therefore, CAPD+ICO is not considered a good value for money, requiring an additional annual budget of approximately 58 million THB (2 million USD). These findings provide important economic evaluation evidence to support policy decision-making alongside clinical effectiveness and equity considerations in guiding future UHC benefit package decisions for dialysis modalities among ESRD patients with fluid and sodium overload in Thailand.

Given the lack of cost-effectiveness information, continuous ambulatory peritoneal dialysis (CAPD) with icodextrin (CAPD+ICO) has not yet been included in the Universal Health Coverage (UHC) scheme. This study aimed to evaluate the cost-utility of dialysis treatments for end-stage renal disease (ESRD) patients with fluid and sodium overload, comparing CAPD+ICO and automated peritoneal dialysis (APD) against glucose-based CAPD. A Markov model was applied to evaluate lifetime costs and health outcomes from a societal perspective. Data, including transitional probabilities, direct medical and non-medical costs, and utilities, were collected from randomized controlled trials conducted across 16 hospitals in various regions of Thailand. Compared to glucose-based CAPD, the incremental cost-effectiveness ratio (ICER) for CAPD+ICO was 908,440 THB (26,082 USD) per quality-adjusted life year (QALY) gained, while APD was dominated, incurring higher costs and yielding fewer QALYs. The results indicated that glucose-based CAPD had a 90% probability of being the most cost-effective option from a societal perspective, based on Thailand’s willingness-to-pay (WTP) threshold of 160,000 THB (4,603 USD) per QALY gained. Therefore, CAPD+ICO is not considered a good value for money, requiring an additional annual budget of approximately 58 million THB (2 million USD). These findings provide important economic evaluation evidence to support policy decision-making alongside clinical effectiveness and equity considerations in guiding future UHC benefit package decisions for dialysis modalities among ESRD patients with fluid and sodium overload in Thailand.

Procurement activities in healthcare, especially within nephrology, contribute significantly to the environmental footprint. In peritoneal dialysis (PD), procurement of consumables such as dialysis bags, tubing, and machines plays a critical role in driving environmental impacts. Previous studies, including those by the National Health Service (NHS), have shown that procurement can account for up to 72% of the healthcare sector's carbon emissions. A life cycle assessment (LCA) was conducted from April to July 2024 at the Nephrology Dialysis and Kidney Transplantation Unit of AOU Policlinico di Modena, Italy, in accordance with ISO 14040/14044 standards. The study focused on procurement-related environmental impacts in automated peritoneal dialysis (APD), based on a standard prescription of two 5L bags overnight and one 2L daytime dwell per day. Products were dismantled to assess materials and modelled using OpenLCA with the Ecoinvent v3.10 database. Transportation, manufacturing, and waste disposal were included within system boundaries. The 5L Dialysate Bag (used twice daily) had the highest carbon footprint (1515kg carbon dioxide equivalent [CO2-eq/year]), followed by the 2L Bag (457kg) and Automated Drainage System (286kg). Primary drivers were long-distance transport, plastic production (especially polyethylene and PVC), and energy-intensive manufacturing. Although the 5L bags are used in greater quantities due to the APD prescription (typically two bags per night), it still showed a lower carbon footprint per litre of dialysate delivered (0.415kg CO2-eq/L) compared to the 2L bag (0.626kg CO2-eq/L). Smaller items like disinfectant sprays and medical kits contributed less individually but were used frequently. Across all categories, plastic production, packaging, electricity use, and incineration were key contributors. The environmental impact of PD procurement is concentrated in a few high-use, high-impact items. Reduction strategies should target material substitutions, modular product design, and lower-emission transport and energy use. Innovations such as local dialysate mixing, improved waste segregation, and increased recyclability could substantially reduce the environmental burden of PD.

BackgroundThe impact of incremental peritoneal dialysis (PD) on outcomes is poorly understood, and there is a paucity of evidence informing best practices regarding the dialysis dose at the commencement of PD. This international prospective cohort study aimed to compare PD prescription practices at dialysis commencement and their subsequent association with clinical outcomes.MethodsAdult patients who started PD for less than three months at the time of enrolment in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) between 1 January 2014 and 31 December 2017 were included. Patients were defined as initiating incremental PD if prescribed a total of <4 exchanges/day for continuous ambulatory peritoneal dialysis (CAPD) or, with dry days or having PD less than seven days per week for automated peritoneal dialysis (APD). All other prescriptions were considered standard PD. The primary outcome was the transfer to haemodialysis (HD). Secondary outcomes included peritonitis rate, time to first peritonitis and mortality. Logistic regression analysed PD uptake and the Cox proportional hazards regression model analysed HD transfer, peritonitis and patient survival.ResultsOverall, 1365 PD patients from 128 facilities across seven countries were included. Fewer individuals started on incremental PD than standard PD (37% vs 63%, p < 0.001). Higher incremental PD uptake was associated with receiving treatment in Japan (odds ratio [OR] 2.35, 95% CI 1.05-5.26, p = 0.04; ref: Canada), age >75 years (OR 1.51, 95% CI 1.02-2.24, p = 0.04), icodextrin use (OR 8.54, 95% CI 6.26-11.64, p < 0.001), lower serum creatinine concentration at PD start (OR 1.01, 95% CI 1.01-1.01, p = 0.007) and higher number of PD patients at a facility (OR 1.01, 95% CI 1.00-1.01, p = 0.02). Crude HD transfer rates for the incremental and standard PD groups were 0.14 (95% CI, 0.12-0.16) and 0.15 (95% CI, 0.13-0.17) per patient-year of follow-up, respectively (incidence rate ratio [IRR], 0.93; 95% CI, 0.75-1.15; p = 0.49). There was no significant difference in the hazard of HD transfer between the incremental and standard PD groups (hazard ratio [HR] 0.87, 95% CI 0.68-1.12, p = 0.29). There were also no differences between the two groups concerning peritonitis and mortality.ConclusionsIncremental PD start was prescribed in approximately one-third of patients and, in low certainty evidence, was associated with comparable risks of HD transfer, peritonitis and death.

Abstract Background and Aims Technique survival on peritoneal dialysis (PD) is limited by treatment-related infections, mechanical catheter problems, psychosocial challenges, and/or peritoneal membrane failure. Traditionally, the evaluation of the peritoneal membrane function involves the time- and resource-consuming peritoneal equilibrium test (PET). Our group recently suggested that a glucose-corrected ultrafiltration (gcUF), calculated from cycler machine-readouts, may serve as a valuable and cost-effective biomarker for real-time peritoneal membrane monitoring. The aim of this study therefore was to evaluate this biomarker alongside other real-world treatment response measures in context of dialysis prescription to predict adverse outcomes in a large single-center cohort of patients on automated PD (APD). Method For this retrospective study we collected and analyzed daily APD cycler treatment response measures (as direct machine readouts) and prescription data of adult patients on APD treated between 2000–2022 at the Medical University of Vienna. Prescription data (i.e., daily glucose load, prescribed dialysis fluid volume) and subsequent treatment response measures (i.e., gcUF, cycler ultrafiltration) was evaluated at an extended baseline period during the first three months of APD in daily, weekly or monthly intervals for the prediction of technique failure (death or transfer to hemodialysis) and major adverse peritoneal events (MAPE, first occurrence of either PD-associated peritonitis or transfer to hemodialysis). This analysis was conducted with Kaplan Meier curves and Cox proportional hazard regression with empirical covariate selection ( compared to a stepwise forward selection procedure). Receiver operating characteristic analysis was conducted to analyze model performance and calculate area under the curve (AUC) measurements with respective 95% confidence intervals (95% CIs), sensitivity, specificity, and to find optimal thresholds for endpoint prediction in selected models. Results A total of 171/308 (56%) of patients treated with APD for home dialysis for 2.5 ± 1.9 years at mean (± standard deviation) were included. The analyzed patients were in 61% male, 54 ± 15 years of age at mean, and in 27% diabetic. 29% of patients were transferred to hemodialysis, and 29% of patients died on APD, corresponding to an all-cause technique failure-rate of 58%. Daily and weekly machine-readout cycler ultrafiltration at baseline significantly (P = 0.04 and P = 0.02, respectively) predicted transfer to hemodialysis, with an AUC of 0.6. While gcUF at baseline displayed the same AUC, covariate-adjusted Cox regression resulted only in a predictive trend (P = 0.08). Surprisingly, daily prescribed glucose loads were significant predictors of MAPE in the empirically adjusted and covariate forward selection procedure models (P = 0.03 and P = 0.02), with an AUC of 0.68. In addition, daily glucose loads were higher at baseline in patients who died on APD than in patients transferred to HD later during their treatment course (P = 0.05). Conclusion These data support the value of extended baseline measures, such as treatment response measures (as direct machine readouts) and prescription data for potential stratification of patients on APD with higher risk for adverse treatment trajectories and outcomes. Adding prescription data (such as the daily glucose load) to remote cloud-based APD analysis software thereby holds the potential to improve patient outcomes by providing the hospital-based dialysis team with the necessary toolkit for timely and rigorous treatment analysis and subsequent intervention.

Abstract Background and Aims Prescriptions that can correct hypervolemia in automated peritoneal dialysis (APD) reduce patient complications. Using the Sharesource remote patient monitoring programme, it has been observed that some APD patients have no or low UF, especially in the early cycles. However, in continuous ambulatory peritoneal dialysis, ultrafiltration is higher when the patient is first connected to dialysis and during the first few hours when the patient is more hypervolemic. Determining which has the most UF from these cycles will show us the best UF time in the patient's treatment and help to reduce hypervolemia. In our study, we aimed to evaluate the UF amounts of the patients during the nocturnal cycles. Method The study included 32 patients (13 women, 19 men) who had been on APD for at least 3 months. The mean age of the patients was 58.4 ± 17.3 years (26–87). Patients were euvolemic and non-infection. Drainage volumes of each night cycle of the last month were averaged. The UF volume was calculated for each cycle. Patient UF profiles were calculated using descriptive analysis. UF profiles were compared between tidal therapy and standard therapy. In addition, both groups were evaluated for PET KTV. Results When all patients were evaluated, 1 patient had 4 cycles, 17 patients had 5 cycles, 11 patients had 6 cycles and 3 patients had 7 cycles. UF averages were calculated for each cycle in the patients. The mean UF levels of the patients are shown in the graphs (Figs 1 and 2). While 20 of the patients received conventional APD treatment, 11 received tidal treatment. When both treatment groups were evaluated, it was seen that the amount of UF decreased until the third filling in tidal treatment, that is, until complete drainage was achieved, and increased in subsequent cycle. In the standard treatment, it was seen that ultrafiltration gradually increased with each drainage. There was no difference in total UF between the two treatment methods. In 20 patients receiving standard treatment, positive UF was 67.9% in the first cycle, 85.7% in the second cycle, 90.5% in the third cycle, 95.2% in the fourth cycle, and 85.7% in the fifth cycle. The number of cases was low in the 6th and 7th cycles, but there were positive UF. When the patients receiving tidal and standard treatment were evaluated together, negative UF was also obtained in the 4th cycle due to the tidal treatment application procedure. There was no difference between PET and KTV between the two groups (P = 0.25, P = 0.62 respectively). Conclusion A pattern of increasing UF with increasing number of cycles has been observed with standard therapy. This may help to guide treatment options in APD. The pattern of increasing UF, usually in the first few hours with the expected first fill in CAPD, was found to be more pronounced with subsequent cycles in APD. This may represent a different kinetic pattern. The nightly sleeping position and the increase in peritoneal interstitial glucose may contribute to this situation. In addition, endogenous hormones (such as ADH, catecholamines, prolactin) whose levels change during the night may also play a role, but further studies are needed.

Abstract Background and Aims Patients undergoing nocturnal automated peritoneal dialysis (APD) experience fluctuations in intra-abdominal pressure due to the cyclic loading and unloading of dialysate. These fluctuations may impact diaphragmatic and pulmonary function, supporting the rostral fluid shift hypothesis as a contributing factor to sleep apnea. However, no scientific studies have specifically examined the effects of APD on respiratory physiology during sleep. This study aims to evaluate the impact of peritoneal dialysis on various polysomnographic parameters. Method We analyzed data from 18 out of 60 patients (30%) undergoing APD for at least six months at our center, all with a BMI between 25 and 30 kg/m². Seventeen patients were on APD, while one was on continuous ambulatory peritoneal dialysis (CAPD). We assessed underlying kidney disease, polygraphy results (cardiorespiratory nocturnal monitoring), intra-abdominal pressure measurements, and dialysis treatment settings. Results In our cohort, 22.2% of patients had autosomal dominant polycystic kidney disease (ADPKD). Patients had been on APD for an average of 30 ± 36 months, with mean dialysate volumes of 1655 ± 409 mL, an average BMI of 25.6 ± 4.5 kg/m², an intraperitoneal pressure (IPP) of 15 ± 3.7 cm H₂O, and an average Kt/V of 2 ± 0.5. One patient had chronic obstructive pulmonary disease (COPD), and another presented with an influenza-like illness at the time of polygraphy. Obstructive sleep apnea (OSA) was detected in all patients: 62.5% had moderate sleep apnea (mean apnea-hypopnea index [AHI]: 23.35 ± 3.5 events/hour).25% had severe sleep apnea (mean AHI: 41.7 ± 2 events/hour).The remaining patients had mild sleep apnea (mean AHI: 8.6 ± 4.1 events/hour). In 61% of cases, the supine AHI/non-supine AHI ratio exceeded 2, indicating positional sleep apnea based on AASM criteria. Conclusion Our findings indicate that all patients in this study had OSA, highlighting the potential underdiagnosis of sleep apnea in this population. Despite its significant clinical implications, sleep apnea is often overlooked in dialysis patients. Given these findings, we recommend routine screening for sleep apnea in all patients under renal replacement therapy, not only those on APD, even in the absence of overt symptoms.

Abstract Background and Aims Initiating dialysis in an unplanned manner is a frequent clinical challenge. Haemodialysis (HD) remains the most utilized modality in such cases; however, there is limited evidence comparing its efficacy to peritoneal dialysis (PD) in this context. This study aimed to evaluate the feasibility, safety, and outcomes of automated PD with immediate start (APD-IS) compared to urgent-start HD in patients initiating unplanned dialysis. Method Patients who initiated unplanned dialysis between January 2022 and January 2024 were prospectively included. Unplanned dialysis was defined as the initiation of dialysis in patients without prior vascular access or PD catheter placement. Patients with severe hyperkalaemia (serum potassium &amp;gt;6 mEq/L or electrocardiographic changes), pulmonary oedema requiring ventilatory support, or those on dual antiplatelet therapy were excluded. Eligible patients were offered the choice of HD or PD. Patients opting for PD underwent percutaneous insertion of a double-cuffed straight Tenckhoff catheter at the bedside by a nephrologist. Immediate-start APD is a novel technique in which low-volume exchanges (500 mL) using a cycler and 1.5% dextrose solution were initiated within 24 hours with the patient in supine position. APD was continued for 7 days, after which patients transitioned to manual exchanges or continued APD based on preference. Patients choosing HD were initiated via a temporary non-tunnelled catheter. Definitive vascular access, including tunnelled catheters or arteriovenous (AV) fistulas, was established once patients were stabilized. Patients were followed for 6 months to assess outcomes including mortality, hospitalizations, and technique survival. Complications such as infections, catheter dysfunction, and access-related issues were also monitored. Results Of 78 patients initiating unplanned dialysis, 13 were excluded (5 for hyperkalaemia, 4 for ventilatory support, and 4 for dual antiplatelet therapy). Among the 65 eligible patients, 32 (49%) chose PD, while 33 opted for HD. PD catheter placement was performed percutaneously, with 26 procedures conducted in the operating room and 6 in the ICU. The median time to initiation of PD was 16.5 hours (IQR 12–22). Complications included peri-catheter leaks in 3 patients (resolved with temporary cessation), and abdominal discomfort in 2 patients (delayed initiation by 48 hours). All patients achieved normalization of biochemical parameters and symptom relief. HD initiation occurred via temporary catheters, with a median time of 3.6 hours (IQR 0.5–33). Temporary catheter use lasted a median of 29 days. Of the HD group, 15 transitioned to tunnelled catheters, and 12 underwent AV fistula creation (median time to creation: 3.6 months; median time to utilization: 1.8 months). The initial hospitalization duration was similar between the groups (PD: 12 days vs. HD: 14 days, P = 0.7). Infection rates were significantly lower in the PD group (bacteraemia: 2 vs. 14 cases; peritonitis: 6 episodes vs. 14 cases of catheter-related bloodstream infections [CRBSI]). Exit-site bleeding occurred in 3 HD patients but was absent in the PD group. Mortality was lower in the PD group (3%) compared to HD (18%). Technique survival at 6 months was higher in PD (87.5% vs. 75.8%), as was patient survival at 1 year (96.9% vs.81.8%). Hospitalizations were significantly lower in the PD group compared to HD group (12.5% vs. 54.5%). Conclusion Immediate-start automated peritoneal dialysis (APD-IS) is a feasible &amp; safe alternative to HD for unplanned dialysis initiation. It has good acceptance rate among these patients. It is associated with reduced infection rates, fewer interventions, better technique survival, and improved patient outcomes. It is also has significantly lesser number of hospitalizations during the 6 months follow-up period. These findings highlight the potential of APD-IS as a viable modality in the unplanned dialysis setting.

Abstract Background and Aims The application of telemedicine in automated peritoneal dialysis (APD) through teledialysis (TD) programs has shown promising benefits in improving patient outcomes, reducing hospitalizations, and optimizing healthcare resources. This study aims to evaluate the impact of TD on clinical effectiveness, resource utilization, and patient survival, comparing APD patients managed via telehealth with those undergoing conventional in-center hemodialysis (HD). Method A retrospective analysis was conducted on incident dialysis patients over a 3-year period. A total of 44 APD patients enrolled in a teledialysis program were compared with 73 incident HD patients managed through standard care. TD was performed by the combination of two systems: Results APD patients in the teledialysis program had significantly fewer hospitalizations per patient (0.77 vs. 2.81 in HD, P &amp;lt; 0.05) and showed a lower absolute mortality rate compared to HD (27.6 vs. 52.5 deaths, respectively), possibly reflecting differences in baseline patient characteristics. [Table 1] Conclusion Teledialysis in APD demonstrates significant advantages in reducing hospitalizations and optimizing healthcare resource allocation. TD offers a viable and effective alternative to in-center HD, promoting patient-centered, cost-effective care. Further prospective studies are warranted to refine patient stratification and assess long-term survival benefits.

Abstract Background and Aims Achieving adequate ultrafiltration (UF) as well as adequate sodium removal is a challenge in patients treated with peritoneal dialysis (PD), especially during automated PD (APD) as a result of sodium sieving. Carry Life UF is a novel PD system, using the concept of steady concentration peritoneal dialysis (SCPD), where glucose is added continuously during the PD dwell to maintain a stable intraperitoneal glucose concentration, thereby enabling effective UF throughout the whole duration of the dwell. During the entire treatment with the Carry Life UF system a small portion of the intraperitoneal fluid is repeatedly transferred to the device, where it is mixed with a small volume of a 50% glucose solution, and then returned to the patient. The aim of this study was to investigate ultrafiltration, sodium removal and glucose efficiency using the Carry Life UF system. Method Eight stable adult patients (2 females) treated with continuous ambulatory PD (CAPD) were included in the study. The participants underwent three 5-hour Carry Life UF treatments using different glucose doses (11, 14, 20 g/h). An initial fill with 1500 ml, 1.36% glucose PD solution was used. A standard 4-hour 2.27% glucose CAPD dwell was used as the control. UF volume, sodium removal, and glucose absorption was calculated as well as glucose efficiency for UF (mL UF volume/g glucose absorbed), and for sodium removal (mmol sodium removed/g glucose absorbed). Data are expressed as mean ± SD, statistical analysis using one-way ANOVA, *P &amp;lt; 0.05, **P &amp;lt; 0.01, ***P &amp;lt; 0.001. Results The results from control and Carry Life UF treatments are shown in the Table 1 and Fig. 1. Compared to the control treatment, there was an increase in UF volume (4–5 times) for the Carry Life treatments, as well as a proportional increase (4–5 times) in sodium removal. Glucose absorption increased during the Carry Life UF treatments compared to the control, however, the glucose UF efficiency was increased (2–3 times) with the Carry Life UF treatments. Further, increased sodium removal per absorbed gram of glucose (2–3 times) was noted, which was statistically significant for the Carry Life UF 11 g/h and the 14 g/h glucose doses. There was a strong positive correlation (r = 0.98) between UF volume and sodium removal for the Carry Life UF treatments. Conclusion The simultaneous increase in UF volume and sodium removal with SCPD performed with the Carry Life UF system compared to the control is a clinical benefit. The increased UF volume with the Carry Life UF treatments compared to control, was associated with an increase in glucose absorption, which, however, was not proportional to the increase in UF. Hence, glucose UF efficiency was significantly higher with the Carry Life UF treatments compared to control. Furthermore, also glucose sodium removal efficiency was increased with the Carry Life UF treatments. The strong correlation between UF volume and sodium removal with SCPD is in contrast to the situation with APD, where an increased UF volume does not result in a proportional increase in sodium removal. In summary, SCPD performed with the Carry Life UF system resulted in higher UF, greater and predictable sodium removal and more efficient use of glucose, both with respect to UF and sodium removal, and is potentially a suitable therapy to improve volume management in PD patients. Trial registration number: NCT03724682 (ClinicalTrials.gov).

Abstract Background and Aims Patients with advanced chronic kidney disease (CKD) and a limited life expectancy face significant challenges in accessing high-quality care. Peritoneal dialysis (PD) as a palliative therapy has demonstrated potential to improve symptom management. This study highlights the role of telemedicine in enhancing automated peritoneal dialysis (APD) care, enabling remote monitoring, and optimizing healthcare resources Method A retrospective analysis was conducted on 6 patients with advanced CKD and an estimated life expectancy of more than 6 months, enrolled in a telemedicine-integrated APD program. All patients underwent APD supported by telemonitoring and teledialysis systems, which provided real-time tracking of dialysis performance and patient status. Key metrics analyzed included hospital admissions, number of healthcare services provided, Charlson Comorbidity Index, and Rein score. Teledialysis (TD) was performed using a combination of two integrated systems: Daily monitoring of PD sessions was conducted through Sharesource© (Vantive SRL), while clinical evaluations and training were performed using the eVISUS System® (T4MED, Italy) Results The integration of telemedicine significantly improved clinical outcomes and resource efficiency. The average age of patients was 81.2 years, with a mean Charlson Comorbidity Index of 16.5 and a mean Rein Score of 9. Hospital admissions were minimized to an average of 1.8 per patient, while the average number of healthcare services provided was 5.8 per patient. Patients and caregivers expressed satisfaction with the ease of access to healthcare professionals and the reduction in logistical burdens. [Table 1 and Fig. 1] Conclusion Telemedicine enhances the delivery of automated peritoneal dialysis for palliative care, offering an innovative approach to managing complex patients with advanced CKD. By reducing hospitalizations and optimizing service delivery, telemedicine represents a cost-effective and resource-efficient model for palliative nephrology care.

Abstract Background and Aims Peritonitis is the leading cause of technical failure in peritoneal dialysis (PD), often resulting in the cessation of home dialysis. Culture-negative peritonitis poses unique management challenges with limited evidence on optimal strategies. Method This retrospective cohort study included consecutive cases of PD-associated peritonitis from 2013 to 2023 in the PD center of Peking Union Medical College Hospital. The clinical data were extracted from electronic health records. The diagnosis, classification, and outcomes of peritonitis were consistent with ISPD guidelines. Depending on the characteristics of the data, comparisons between groups were conducted using t-tests, Mann–Whitney tests, or Fisher’s exact test. Logistic regression was used to analyze the correlation between various factors and outcomes. Results Culture-negative (CN) peritonitis accounted for 25.5% (63/247) of all peritonitis. Compared with culture-positive (CP) peritonitis, patients with CN peritonitis were more likely to have smoked (P = 0.031) and had significantly higher rates of antibiotic use before culture collection (47.6% vs. 9.2%, P &amp;lt; 0.0001). Baseline characteristics, including age, diabetes status, BMI, PD modality, and pre-peritonitis bloodwork, were comparable. In multivariate logistic regression, only smoking history (OR = 2.01, 95% CI: [1.024, 3.945], P = 0.042) and the use of antibiotics before culture collection (OR = 58.59, 95% CI: [3.942, 19.54], P &amp;lt; 0.0001) were independently associated with negative culture peritonitis. The patients initially presented to the emergency room (ER) experienced higher rates of antibiotic use (27.55% vs. 9.85%, P = 0.0007) and delays in effluent culture collection (average 12.7 hours vs. 1.2 hours, P &amp;lt; 0.0001) than those presented to the PD unit. Multivariate logistic regression analysis indicated that CP peritonitis, automated peritoneal dialysis (APD), and non-first episodes of peritonitis independently predicted the poor prognosis of not being medically cured. CN peritonitis generally had better outcomes with higher medically cured rates and fewer refractory cases. However, a subgroup of patients with comorbidities requiring antibiotics (N = 9) use before culture had the worst prognosis: 4 of them died during peritonitis treatment, and the survivors had a catheter removal rate of 60%. Conclusion Cultural negativity is influenced by the initial presentation’s location and sample collection delays. CN peritonitis generally has favorable outcomes. Special attention is needed for CN peritonitis patients with comorbid infections, as their prognoses are significantly worse. These findings highlight the importance of tailored management strategies for patients with peritonitis, particularly for those with a history of antibiotic use or recurrent episodes.

Abstract Background and Aims Peritoneal dialysis (PD) is a widely used renal replacement therapy; however, its long-term success is influenced by peritoneal membrane integrity and function. This study aims to investigate the relationship between ultrasonographic peritoneal thickness, inflammatory markers, and clinical outcomes in patients undergoing automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD). Method Demographic data and clinical parameters were recorded. Ultrasonographic peritoneal thickness was measured for all patients from four different quadrants of the abdomen. Inflammatory markers, including intraperitoneal and blood IL-6 and MCP-1 levels, were analyzed. Correlations between peritoneal thickness, inflammatory markers, and clinical outcomes were assessed. Additionally, patient outcomes over a two-year follow-up period, including kidney transplantation, switch to hemodialysis due to peritoneal dialysis failure, and mortality were recorded. Results A total of 106 adult peritoneal dialysis patients were included in the study, with 53 undergoing APD and 53 undergoing CAPD. The demographic characteristics of the included patients are presented in Table 1. Analyses revealed that the mean ultrasonographic peritoneal thickness was correlated with intraperitoneal IL-6 (r = 0.211, P = 0.031) and peritoneal fluid MCP-1 levels (r = 0.252, P = 0.010), as well as with blood IL-6 levels (r = 0.320, P = 0.001). However, no significant correlation was found between blood MCP-1 levels and peritoneal thickness (r = −0.009, P = 0.930). In patients with a history of peritonitis, ultrasonographic peritoneal thickness (0.45 (0.20–0.77) vs 0.29 (0.22–0.73), P &amp;lt; 0.001), intraperitoneal IL-6 levels (136.61 (16.21–694.40) vs 19.85 (5.80–1781.00), P &amp;lt; 0.001) and blood Il-6 levels (106.65 (20.12–601.70) vs 55.55 (10.20–372.25), P = 0.001) were found to be significantly higher. Additionally, ultrasonographic peritoneal thickness was observed to increase significantly with decreasing peritoneal permeability in PET testing (Fig. 1) (P = 0.046) and correlated with longer duration on peritoneal dialysis (r = 0.469, P &amp;lt; 0.001). During the two-year follow-up period, 5 patients underwent kidney transplantation, 24 transitioned to hemodialysis due to peritoneal dialysis failure, and 7 patients died from cardiac causes. A significant association was observed between ultrasonographic mean peritoneal thickness and switch to hemodialysis due to PD failure (PD group: 0.29 (0.20–0.67), PD failure group: 0.36 (0.25–0.77), P = 0.002). Conclusion Ultrasonographic peritoneal thickness is significantly associated with intraperitoneal IL-6 and MCP-1 levels, peritoneal permeability, and clinical outcomes in PD patients. The lack of correlation between systemic MCP-1 levels suggests that peritoneal inflammation may be governed by local mechanisms distinct from systemic inflammation. Increased peritoneal thickness correlates with reduced peritoneal permeability, longer PD duration, and history of peritonitis. Furthermore, it is linked to PD failure and adverse patient outcomes. These findings suggest that ultrasonographic peritoneal thickness may serve as a valuable non-invasive marker for monitoring peritoneal membrane integrity and local inflammatory processes and predicting long-term PD outcomes.

Abstract Background and Aims Peritoneal dialysis (PD) is a relatively simple modality of renal replacement therapy (RRT) used in many parts of the world. However, factors such as financial constraints, regulations, and others often influence the choice of dialysis modality, and many misconceptions exist among patients, nurses, and physicians regarding the therapy, including its contraindication for obese patients. The prevalence of obesity is increasing globally, associated with comorbidities that either cause or worsen renal diseases. The aim of this study is to evaluate obesity as a predictor of time on PD in patients who underwent conservative treatment and chose PD as their first RRT. Method Data from a single center in São Paulo, Brazil, were used for this retrospective, observational study, covering patients on PD from 2003 to 2022. Patients aged &amp;gt;15 years, who automatically started automated peritoneal dialysis (APD) at the onset of therapy with a predetermined stage (death, transfer to hemodialysis, or transplant) were included. Body mass index (BMI) was calculated at the admission examination. Statistical analysis was conducted using Jamovi Software Version 2.3 with the most appropriate test for each analysis. Results A total of 312 patients were evaluated, with 53.5% being male, and a mean age of 56.7 ± 16.3 years. According to BMI, 46.5% were eutrophic, 35.3% overweight, and 18.3% obese. The distribution of the etiology of chronic kidney disease (CKD) was diabetes mellitus (31.7%), hypertension (14.7%), glomerulopathy (9.3%), diabetic nephropathy (9.0%), and others (35.5%). The median time and interquartile range on PD for the analyzed patients was 20 (10–34) months. Reasons for discontinuation included death (30.8%), transfer to hemodialysis (42.3%), and transplant (26.9%). The majority of deaths were due to cardiovascular causes (54.2%), most hemodialysis transfers were due to peritonitis (55.3%), and the majority of transplants were from deceased donors (79.8%). Obese patients had a shorter therapy time compared to non-obese patients, 15 vs. 21 months (p = 0.02). After adjusting for age at the start of RRT, sex, etiology, and reason for discontinuation, obesity remained a predictor of shorter time on PD (p = 0.014). Conclusion We conclude that among the patients who chose PD as part of conservative treatment and who were obese at admission, there was a shorter total time on PD therapy, with no differences in the reason for discontinuation. Therefore, these patients should be closely monitored for this condition, and weight reduction intervention strategies should be prioritized, preferably before the choice of dialysis method in conservative treatment. Once on PD, these actions should take place during the first 15 months of therapy to improve technical survival and outcomes for obese patients. Additionally, a multidisciplinary approach involving dieticians, nephrologists, and other healthcare providers is critical in managing obesity within this patient population.

IntroductionTherapy alerts during automated peritoneal dialysis (APD) can cause significant disruptions to patients' sleep and quality of life and may portend poorer outcomes. Understanding the relationship between alert frequency during this early period and longer-term PD outcomes is important.MethodsFollowing the probabilistic linkage of Vantive's Sharesource database to the Australian and New Zealand Dialysis and Transplant (ANZDATA) Registry, we examined the relationship between alert frequency in the first 30 days of APD and PD discontinuation. We included adult patients in Australia and New Zealand who commenced APD with the Vantive Homechoice Claria cycler over 2019-2023 and continued for at least 30 days. The average alerts per treatment in the first 30 days were divided into quartiles and time to PD discontinuation (inclusive of HD transfer and death), HD transfer only, and infective and non-infective HD transfer were modelled as outcomes.ResultsThe cohort was 1880 patients, 65% male, and median age at PD commencement of 58 years. Overall PD continuation at 1,2, and 3 years was 78%, 56% and 41%, with HD transfer rates at 14%, 23% and 27%. Higher rates of HD transfer in the first 12 months were seen in the groups with a higher average alert number. Within 12 months, there was a progressive risk of non-infective HD transfer with increasing 30-day alert quartile.ConclusionAlert burden in the first 30 days is a risk factor for HD transfer in the first 12 months, and resolving underlying issues early may help to improve PD continuation.

Outcome of Peritonitis in Automated Peritoneal Dialysis: A Cohort Study